Hormone Replacement Therapy Does Not Worsen Seborrheic Keratosis
There is no evidence that hormone replacement therapy (HRT) worsens seborrheic keratosis, and the available literature does not establish any causal relationship between these conditions.
Evidence Review
The provided evidence base contains no studies, guidelines, or case reports linking HRT to worsening of seborrheic keratosis. The question appears to arise from a misunderstanding of hormonal influences on skin conditions.
What We Know About Seborrheic Keratosis Pathogenesis
Seborrheic keratosis is a benign epithelial proliferation with increasing incidence related to age and ultraviolet light exposure, not hormonal factors 1.
The pathogenesis involves oncogenic mutations in FGFR-3 and FOXN1, along with alterations in biochemical factors like glutamine deaminases, endothelin, and stem cell factor—none of which are known to be influenced by estrogen or progesterone 2.
Male gender shows preponderance for seborrheic keratosis, which would be inconsistent with estrogen-mediated worsening 2.
Hormonal Therapies and Skin Conditions: What Actually Matters
The evidence does demonstrate hormonal influences on other dermatologic conditions, but not seborrheic keratosis:
Hidradenitis suppurativa is influenced by androgens, with menstrual cycles and pregnancy affecting disease activity, and antiandrogen therapies showing benefit in 55% of treated women 3.
Hereditary angioedema is clearly worsened by estrogen-containing contraceptives and estrogen replacement therapy, with menopause worsening the condition in 32% of patients 3.
Progestogen-only regimens may worsen hidradenitis suppurativa in some cases and should be discontinued if disease worsens 3.
Clinical Implications
Patients with seborrheic keratosis can safely use HRT without concern for worsening their lesions.
If a patient on HRT develops new or worsening seborrheic keratoses, this represents the natural history of the condition (gradual increase in size, thickness, and pigmentation with age) rather than a drug effect 4.
The development of seborrheic keratosis-like lesions with modern targeted cancer drugs (EGFR inhibitors, tyrosine kinase inhibitors) represents a distinct entity related to oncologic therapy, not traditional HRT 1.
Treatment Considerations Remain Unchanged
Treatment decisions for seborrheic keratosis should be based on cosmetic concerns, irritation, or need for histologic confirmation—not hormonal status 4.
First-line treatments remain cryotherapy, shave excision, electrodesiccation, or curettage 4.
Topical hydrogen peroxide 40% shows the greatest evidence for clinical clearance among topical options 5.